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In medicine, the two most important types of doctors for assessing and treating conditions that can lead to diabetes are endocrinologists and primary-care physicians (family or general-medicine doctors, internists, gynecologists). Unfortunately, pediatricians are also increasingly on the frontlines of this effort, as the epidemic of risk for diabetes affects ever-greater numbers of young people in our society.

To head off diabetes, doctors must remain vigilant for two related conditions: insulin resistance and prediabetes. They also have to be knowledgeable about and alert for the associated metabolic syndrome.* The challenge is significant as these conditions rarely produce obvious signs in their early phases. But they place an individual at higher risk for developing type 2 diabetes in which the body no longer responds properly to insulin (in contrast to type 1 diabetes, in which the body does not make enough insulin.)

Endocrinologists play a central role in caring for patient’s whose bodies lose the ability to respond to insulin.

Insulin resistance
For reasons not completely understood, tissues and cells in some individuals lose their ability to respond to insulin. When secreted into the blood by the pancreas, this hormone tells cells in the body to convert and store blood sugar in useful forms for energy inside the cell. When cells lose a significant portion of their ability to react to this signal, blood sugar can be chronically high, leading to diabetes. As the body works to adjust and respond, the pancreas may produce more insulin as necessary feedback to controlling blood glucose; as a result, blood insulin levels may be very high even with a loss of glucose control.

Prediabetes
Similary, patients are considered to be prediabetic when their blood sugar is chronically high, but not high enough to indicate diabetes. Their fasting glucose is above normal, and their glucose tolerance is below normal. Tens of millions of adults in the U.S. have this condition.

A chance to improve health : Weight loss, diet changes, exercise and drug therapy can significantly reduce the risk of developing diabetes and can help to control the disease when it is present.

What Causes These Conditions?

Genes play a role in placing a person at risk for diabetes-related or early-diabetes conditions, so family history is important to consider. Diet is also a factor. In addition, being overweight and not getting enough exercise can significantly increase the chances of developing these conditions.

Are There Signs?

Individuals at danger for type 2 diabetes may experience symptoms of blood-sugar highs-feeling jittery, anxious or irritable due to hyperglycemia after eating carbohydrates or sugars. In general, they may also experience fatigue, difficulty concentrating or sleepiness. However, in most cases, insulin resistance and pre-diabetes do not cause clear symptoms, and the conditions are revealed only by fasting-glucose or glucose-tolerance tests. When these conditions progress further, patients may develop patches or rings of dark skin.

Care For People with Diabetes

Patients who have developed diabetes should have an ongoing relationship with an endocrinologist. Of all types of physicians, these specialists are most trained in and focused on caring for patients with this disease, and they spend the highest portion of their practice time treating it.

Their work involves teaching patients how to combat and limit symptoms, how to test themselves for glucose levels and control, and how to use insulin and other types of diabetes medications. In devising care, they look at the full range of the patient’s needs in health and wellness, in prevention, and in control of complications.

* What is metabolic syndrome?
Also known as syndrome X, metabolic syndrome is closely associated with insulin resistance, prediabetes and diabetes. This syndrome encompasses a constellation of related conditions and symptoms that include hypertension, diabetes, heart and vascular disease, blood lipid disorders and loss of kidney function.